Equal Cath Lab Radiation Seen with Femoral, Radial Access

Action Points

The femoral route has traditionally been the preferred access site for percutaneous coronary interventions and coronary angiograms but the number of procedures performed by the radial route has been increasing since 1989.

Note that this study indicates that selected procedures performed by the radial route are not associated with higher radiation exposure of patients than selected procedures performed by the femoral route.

At a high-volume center with experienced interventional cardiologists, radiation exposure for a patient in the cardiac catheterization lab does not seem to vary based on the type of arterial access, researchers found.

For both percutaneous coronary interventions (PCIs) and coronary angiograms, radiation exposure measured using dose-area product was similar whether access went through the femoral or radial artery, according to Jan Piek, MD, PhD, of the Academic Medical Center in Amsterdam, and colleagues.

The median radiation exposure was 69 Gy cm2 for both types of vascular access (P=0.76), the researchers reported in the July issue of JACC: Cardiovascular Interventions.

Entering through the femoral artery has been the primary approach for cardiac catheterization procedures, although access through the radial artery has been growing in popularity since it was introduced in 1989.

Some studies have examined differences in radiation exposure for the patient based on the access route, but the results have been conflicting, with some studies showing no difference and others showing lower exposure with femoral access.

To explore the issue, Piek and colleagues examined data on 3,973 patients who underwent PCI or coronary angiography from June 2004 through December 2008 at their center. The information was collected prospectively as part of a cardiac catheterization registry.

During the study period, there were six interventional cardiologists working in the cath lab, and all of them were experienced in both femoral and radial access.

The median fluoroscopy time was longer with femoral access than radial (12.4 versus 11 minutes, P<0.001), but that did not translate into greater radiation exposure for the patients.

For PCIs, the median exposure was 75 Gy cm2 for the femoral route and 72 Gy cm2 for the radial route (P=0.30). For angiograms, the exposures were 44 and 40 Gy cm2 for the femoral and radial routes respectively (P=0.31).

The observed radiation exposure for patients undergoing either PCI or angiography through the radial artery was not higher than what was predicted using a model based on exposure from femoral access (71.5 Gy ·cm2 observed versus 79.8 Gy cm2 predicted).

The findings of the study are consistent with two previous studies that did not show a difference in patient radiation exposure based on access type during PCIs.

But the results conflict with those from two other studies.

In one of them, the interventional cardiologists were experienced in the femoral approach and used the radial approach as a complementary technique for PCI. The results of the second study were biased, according to Piek and colleagues, because the average body weight was lower in the femoral group.

Three previous studies looking at exposure during coronary angiograms, however, all showed lower patient radiation exposure using the femoral route.

Piek and colleagues acknowledged that the findings of the current study may not be generalizable beyond high-volume centers with interventional cardiologists experienced using both femoral and radial access.

The analysis was limited, they said, by the lack of a measure of radiation exposure among the operators, the lack of data on conversion from radial to femoral access, and the nonrandomized selection of patients for one approach or the other, which was done by the interventional cardiologists.

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